Breast Augmentation Research Articles

Breastfeeding Outcome and Complications in Females With Breast Implants: A Systematic Review and Meta-Analysis.

Breast augmentation is a commonly performed cosmetic procedure. We set out to determine whether there was any effect on breastfeeding in females after breast implants. The aim of this study was to perform a systematic review and meta-analysis of the current evidence on breastfeeding outcome and complications in females with breast augmentation. A systematic review was performed utilizing MEDLINE, EMBASE, and all evidence-based medicine reviews from their respective inception dates to November 7, 2022, to assess outcomes of breastfeeding in females with breast implants (PROSPERO ID: CRD42022357909). This review was in accordance with both the Cochrane Handbook for Systematic Review of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eleven studies (4 prospective and 7 retrospective) in total were included in the review. A total of 8197 out of 9965 (82.25%) patients were successfully able to breastfeed after breast implants. Of 5 studies that included a control group, 343,793 of 388,695 (88.45%) women without breast implants successfully breastfed. A meta-analysis of 5 comparative studies showed a significant reduction of breastfeeding in females with breast implants, n = 393,686, pooled odds ratio = 0.45 (95% CI, 0.38 to 0.53). Complications described included pain, mastitis, insufficient or excessive lactation, and nipple inversion. There may be impairment in ability to breastfeed for females who receive breast implants when compared with those without. Additional studies on the topic are needed to further clarify the relationship.

Use of a biological scaffold in the cleavage area in complex revision breast augmentation: A surgical technique and case series

BackgroundBilateral breast augmentation has been the top surgical procedure performed worldwide by plastic surgeons for the past 5 years. Complex breast revision patients are challenging, with the cleavage area being one of the most difficult areas to navigate. We present a novel technique for using biological scaffolds in revision breast augmentation surgery. MethodsA step-by-step surgical technique is presented, combined with a series of 11 cases where either SurgiMend® acellular dermal matrix (ADM) or GalaFLEX mesh was used specifically in the medial cleavage area to correct a difficult to manage soft tissue contour deformity. ResultsEleven patients underwent revision breast augmentation with the use of the biological scaffolds in the medial cleavage area. The mean age was 43 years with a range of 29–68 years. All replacement breast implants were anatomical-shaped, medium profile, polyurethane-coated implants. GalaFLEX® mesh was used in six patients; five patients received SurgiMend® ADM. Mastopexy was performed in 8/11 patients. There were two complications in the same patient in this series, one emergency return to theater for bleeding and one minor scar revision. ConclusionsRevision breast augmentation surgery includes a smorgasbord of options that can be used individually or in combination, such as full or partial capsulectomy, removal alone or replacement of the implant, change to the tissue plane of where the implant sits, mastopexy, and fat transfer. In addition to these recognized treatments, we would like to advocate the option of a biological scaffold for extra support of the cleavage area in complex revision cases.

Augmented Reality-Assisted Ultrasound Breast Biopsy.

Breast cancer is the most prevalent cancer in the world and the fifth-leading cause of cancer-related death. Treatment is effective in the early stages. Thus, a need to screen considerable portions of the population is crucial. When the screening procedure uncovers a suspect lesion, a biopsy is performed to assess its potential for malignancy. This procedure is usually performed using real-time Ultrasound (US) imaging. This work proposes a visualization system for US breast biopsy. It consists of an application running on AR glasses that interact with a computer application. The AR glasses track the position of QR codes mounted on an US probe and a biopsy needle. US images are shown in the user's field of view with enhanced lesion visualization and needle trajectory. To validate the system, latency of the transmission of US images was evaluated. Usability assessment compared our proposed prototype with a traditional approach with different users. It showed that needle alignment was more precise, with 92.67 ± 2.32° in our prototype versus 89.99 ± 37.49° in a traditional system. The users also reached the lesion more accurately. Overall, the proposed solution presents promising results, and the use of AR glasses as a tracking and visualization device exhibited good performance.

Pain syndrome therapy in patients after mammoplasty

Purpose of the study: to study the efficacy and safety of the intravenous form of ibuprofen “Intrafen” 800 mg in patients after mammoplasty.Material and methods. The use of intravenous ibuprofen “Intrafen” 800 mg on the day of surgery for 200.0 0.9% sodium chloride solution and the next day in 27 patients of the main group after mammoplasty at the Clinic of Plastic Surgery DR. SABAZBEKOV" (Almaty, the Republic of Kazakhstan). The inclusion criterion was informed consent to mammoplasty and the absence of contraindications to the administration of Intrafen according to the instructions. The control group also consisted of 27 patients who underwent mammoplasty; as non-steroidal antiinflammatory drugs, they were prescribed a solution of ketoprofen 100 mg/day intramuscularly once.Result and discussion. The following types of plastic surgery on the mammary glands were performed: augmentation mammoplasty – 8 (29.6%), reduction mammoplasty – 10 (37.0%) and isolated mastopexy – 9 (33.4%). The intensity of pain on the VAS scale on the day of surgery was (4.5 ± 0.5) points, on the 1st day the relief was up to (1.4 ± 0.5) points. Hemodynamic parameters within 1 day were within normal limits: systolic blood pressure (113.9 ± 7.0) mm Hg, diastolic blood pressure (73.2 ± 6.47) mm Hg, heart rate (79.1 ± 4,9) beats per minute, saturation (99.6 ± 0.68) %. No gastrointestinal disturbances were found in the control group. The intensity of pain syndrome after surgery was (8.4 ± 1.3) points according to the VAS, which required the administration of an opioid solution of tramadol hydrochloride 100 mg/day and on the day of discharge the VAS was (4.1 ± 0.75) points, followed by the appointment of a solution of ketoprofen 100 mg/day once.Conclusion. The intravenous form of ibuprofen “Intrafen” 800 mg once a day of surgery and then 1600 mg/day during the day is effective for relieving pain in patients after mammoplasty and is safe due to the absence of adverse events from the gastrointestinal tract and stable hemodynamics.

The technology of installation of breast implants in the subpectoral space while preservation attachment of the abdominal part of the pectoralis major muscle

The paper describes the technology of installing breast implants in the subpectoral cellular space while maintaining the attachment of the abdominal part of the pectoralis major muscle and evaluate the results of its application. A retrospective analysis of the results of primary breast augmentation in 762 patients operated by the authors in 2010–2020 was carried out.The space for the breast implant was formed following a certain sequence of actions. The boundaries of the receptacle were: inside – the place of attachment of the pectoralis major muscle to the sternum, outside – the abdominal part of the pectoralis major muscle and the pectoral fascia, passing to the bundles of the anterior serratus muscle, at the top – thoracoacromial vascular bundle, below – VI rib and fascial node, formed by the transition of the thoracic fascia and the aponeurosis of the abdominal part of the pectoralis major muscle to the anterior wall of the sheath of the rectus abdominis muscle. Conclusions. 1. The technology of installing implants in the subpectoral cellular space, while maintaining the distal attachment of its abdominal part, allows achieving the stability of the position of the implants and avoiding rotation and malposition of the implants. 2. In terms of up to 3–4 months after surgery, a higher location of implants on the chest is often observed. 3. The decision on the need and degree of mobilization of the abdominal part of the pectoralis major muscle should be made individually. 4. The technique cannot be used when the width of the implant base exceeds the width of the pectoralis major muscle at the level of the IV rib, and, therefore, limits the choice of larger implants.

Anatomic Study of the Integrity of the Breast Lymphatic Network With Indocyanine Green in Breast Implant Surgery Through the Axillary Approach.

The performance of a prosthetic breast augmentation through the axilla always makes the surgeon fear the possibility of damage to the breast lymphatic network. Indocyanine green is a fluorescent marker allowing the analysis of the lymphatic system. This anatomical work aims at demonstrating, thanks to the use of indocyanine green, whether the realization of a prosthetic breast augmentation by axillary way leads to lesions of the breast lymphatic network and also seeks to show the feasibility of detecting the axillary sentinel node after axillary breast augmentation. This is an anatomical study. After injection of indocyanine green in the periareolar area, a prosthetic breast augmentation was performed through the axilla. At the end of the procedure, a change in the distribution of indocyanine green in the skin or its abnormal presence was sought: at the level of the skin incision, the prosthetic space, or in contact with the prosthesis itself. The presence of green in these situations was synonymous with a lesion of the lymphatic network. In the opposite case, we considered that the lymphatic system was respected. After sampling, an axillary lymph node we also looked for the presence of indocyanine green at its contact. We performed 22 breast injections. The lymphatic network could be demonstrated in 15 of them. Among these 15 injections, 12 (80%) were in favor of a preservation of the lymphatic network, whereas 3 (20%) evoked a lesion of the lymphatic network. In all subjects (100%), an axillary lymph node was found with the presence of indocyanine green within it. Our study is in favor of a preservation of the lymphatic network during a prosthetic breast augmentation by axillary way. Furthermore, with the collection of an axillary lymph node containing the dye from each subject, this work demonstrates the feasibility of axillary sentinel node detection with indocyanine green after axillary breast augmentation. Further work on live subjects and on a larger number of subjects would be necessary to confirm these results.

Complications and management of breast augmentation using two different types of fillers: a case series

An advantage of breast augmentation with injectable fillers is that the desired size can be determined and achieved under local anesthesia with a short recovery time. However, a high complication rate is a critical disadvantage. Some fillers are challenging to remove, resulting in breast deformity and scarring. Five patients who underwent surgery to manage a foreign body in the breasts in 2021 were enrolled in this study. Two had copolyamide filler injections, while the other three had polyacrylamide hydrogel filler injections. A physical examination was performed, and preoperative and intraoperative photographs were obtained. Two patients underwent subcutaneous mastectomy because most of the filler had infiltrated into the normal breast tissue. In contrast, the other patients underwent filler removal and debridement because most of the filler had remained separate from the normal breast tissue. All patients who had a subcutaneous mastectomy and one who underwent only filler removal underwent immediate breast reconstruction with cohesive gel implants. The other patients rejected immediate reconstruction, and only filler removal was performed. All patients recovered without complications. We propose an algorithm for diagnosis and treatment based on our cases, which we hope can help clinicians manage the complications of filler injections for breast augmentation.

Differential knowledgeability: the case of the chosen breast

ABSTRACT Women’s choice to undergo breast augmentation surgery with silicone implants may develop into a choice to surgically remove them. In our paper, we employ dimensions of power relating to such decisions to elaborate differential knowledgeability as organizing the temporal dimension of the process and its potential for changing the meaning of a decision formerly taken. Until recently, the possibility of differential access to knowledge relating to silicone implants’ hazards was not explored from a temporal perspective, thus leaving vague the weight of women’s participation in digital platforms that constitute knowledge-supporting space. Our findings relate to a turning point in which increased knowledgeability manifests a change in women’s perception of augmentation surgery as a risk and fed a reflexive process towards a decision to remove the implants surgically. The neoliberal discourse our research participants adopted to describe their experiences demonstrates self-critical perception; thus, their increased knowledgeability did not influence the balance of power between women and medical professionals. Our findings also relate to the development of emotional ambivalence post implants removal surgery, anchored in the research participants’ separation from their culturally appreciated former appearance.

Content and Readability of Online Recommendations for Breast Implant Size Selection.

Using a depersonalized, anonymous query to Google search engine, the terms "breast implant size factors" and "breast implant size decision" were searched, and 52 plastic surgery private practice webpages were identified. Webpages were analyzed for reported decision-making factors of implant size selection. Readability analyses of webpages were performed with Readability Studio and Hemingway Editor. The two major decision-making factors for implant size selection reported by webpages were body/tissue-based measurements and surgeon input. Ten factors related to patient lifestyle, surgical goals, and procedural options were also identified. Average webpage scores for five readability measures exceeded recommended levels for medical information. Reported decision-making factors for implant size selection emphasize a plastic surgeon's expertise but may enhance the patient's role in preoperative planning. Webpages describing breast implant size selection exceed the sixth and eighth grade reading levels recommended by the AMA and NIH, respectively. Improving the readability of webpages will refine the role of online medical information in preoperative planning of breast augmentation.

Anatomical Variations of the Pectoralis Muscle and Its Importance for Breast Implant Surgery.

In 84 consecutive aesthetic breast augmentations intraoperatively, measurement of PMM dimensions was performed bilaterally. These PMM measurements were then correlated with the preoperative breast width, the inframammary fold, and the placement of the implant's lower pole. One hundred sixty-eight PMMs of 84 patients were dissected with a dual plane II or III technique for primary aesthetic breast augmentation. In 88% of breasts, the calculated implants' lower pole was below the inferiomedial origin of the pectoralis muscle. In 10% of patients, a separation (more than 1 cm wide and 2 cm wide) in the inferior-medial origin of the PMM was noted. An asymmetry more than 0.5 cm in length between the left and right pectoralis major was noted in 36% of patients. In this series, the anatomy of the PMM demonstrates a substantial variability in width and length and a considerable asymmetry in its dimensions. These findings emphasize the importance of good access and visualization of the origin of the PMM fibers before its division.

Comparing 200,000 Breast Implants and 85,000 Patients over Four National Breast Implant Registries.

Growing awareness about breast implant-related adverse events has stimulated the demand for large, independent data resources. For this, data from breast implant registries could be combined. However, that has never been achieved yet. Real-world data from four currently active national breast implant registries were used. All permanent breast implants from the Australian, Dutch, Swedish, and American registries were included. A subpopulation present across all registries between 2015 and 2018 was subsequently selected, including only permanent breast implants inserted during primary surgery for breast reconstruction or augmentation in patients without previous breast device surgery. Nationwide coverage, patient and implant characteristics, infection control measures, and revision incidences were analyzed. A total of 207,189 breast implants were registered. Nationwide coverage varied between 3% and 98%. The subpopulation included 111,590 implants (7% reconstruction, 93% augmentation). Across the registries, mean patient age varied between 41 and 49 years ( P < 0.001) for reconstruction and 31 and 36 years ( P < 0.001) for augmentation. Variation was observed in implant preferences across the countries and over the years. Infection control measures were most frequently registered in Australia. Cumulative revision incidence at 2 years ranged from 6% to 16% after reconstruction and from 1% to 4% after augmentation. For the first time, independent, national, registry-based data from four breast implant registries were combined. This is a powerful step forward in optimizing international breast implant monitoring, evidence-based decision-making, and patient safety.

Breast asymmetry classification and diagnostics

Breast asymmetry is a polyetiological condition, which may be caused by congenital characteristics, developmental abnormalities, hormonal changes, traumas or surgery. The estimation of breast symmetry should be performed by the plastic surgeon while planning the augmentation or reduction mammoplasty as well as reconstructive surgery. Breast asymmetry is a widespread condition, according to some reports, it can be found in more than half of women. Anthropometric methods, as well as radiology methods, are used to diagnose and estimate breast asymmetry. There are many classification systems of breast asymmetry. The first ones were based on breast appearance or etiology of asymmetry, while modern classifications combine morphologic and etiologic principles. Today there is no conventional diagnostic protocol for breast asymmetry, where it would be listed, which breast parameters should be measured during breast asymmetry estimation. The first attempts were made in the middle of the XX century. Works of Penn, Smith and Westreich are considered to be basic in this field. Generally, relationships between major breast soft-tissue reference points (nipple, areola, submammary fold, lateral border) and bone structures (breastbone, jugular notch, clavicle) are estimated.Mathematic formulas for counting breast volume depending on its linear measurements were developed as well. Nowadays the importance of skeleto-muscular system state (the presence of scoliosis or rib cage deformation) estimation is emphasized, while these conditions can also cause breast asymmetry.

It Is Time to Resolve the Dilemma and Move Away From Using Drains in Primary Breast Augmentation.

Breast augmentation is one of the most commonly performed aesthetic surgical procedures, yet there has been no consensus on the use of drains. While some surgeons believe in using them due to fear of complications or because they were taught in a conventional manner, the authors present their experience of performing breast surgery without the use of drains. To study whether performing breast augmentation without the use of drains is safe. Anthropometric details and complications of all the consecutive primary breast augmentation patients performed by a single surgeon from 2009 to 2022 were collected and analyzed. In none of these patients, drains were used. A total of 429 (21%) patients were lost to follow-up and only those 1617 patients with a minimum follow-up of 6 months were included in this study. The mean age of the study group was 29.8 years with a mean BMI of 24.68. Mean follow-up was 16.24 months. Hematoma occurred in 15 patients (0.92%), seroma in 12 (0.74%), explantation due to infection in 3 patients (0.18%), and capsular contracture in 44 patients (2.72%). All these complications were in the lower range of complications of breast augmentation reported in the literature. Unwarranted use of drains in breast augmentation should be avoided as it does not seemingly prevent the complications of breast augmentation surgery. Instead, it may increase the chances of infection, pain, and discomfort, and prolong the antibiotic coverage, and hence put an additional overall financial burden on the patient.

Patient and Clinician Reported Outcomes of the Inframammary Incision "Short Scar Technique" in Primary Breast Augmentation.

Breast augmentation is a common aesthetic surgery procedure and surgeons are constantly trying to develop techniques that help improve patients' outcome. One of the most important aspects is achieving a favorable scar. The "traditional" breast augmentation scar is in the inframammary fold (IMF), whereas trans-axillary and trans-umbilical approaches have been described as an attempt to move the "location" of the scar and make it less noticeable. Nonetheless, relatively little attention has been paid to improving the IMF scar, which remains the most commonly used scar for silicone implants. The authors have previously described a technique that uses an insertion sleeve and custom-made retractors to allow implant insertion through a shorter IMF scar. However, at the time, the authors did not evaluate the quality of the scar and patient satisfaction. In this manuscript, the authors describe patient and clinician-reported outcomes for this short scar technique. All consecutive female patients, undergoing primary aesthetic breast augmentation with symmetric implants were included in this review. Three different scar-assessment scales demonstrated good results at 1-year postop, as well as the good correlation between patient-reported and clinician-observed scores. BREAST-Q subscale for overall satisfaction also demonstrated good overall patient satisfaction. Besides providing an added aesthetic value to the result of breast augmentation, a shorter scar may also appeal to patients who are concerned about the size and quality of postoperative scars and like to search for "before and after" pictures prior to scheduling consultations.

Breast Augmentation: A Cross-Sectional Survey of UK and Irish Aesthetic Surgeons.

Breast augmentation surgery is the most frequently performed aesthetic surgical procedure within the United Kingdom year on year. However, many variations exist among surgeons regarding various aspects of implant usage and technique. The aim of this study was to evaluate current trends and practices in breast augmentation, within the United Kingdom and correlate them to evidence-based literature. An electronic survey of 41 questions was sent to 201 surgeons performing breast augmentation within the United Kingdom and Republic of Ireland. The survey inquired about the surgeons themselves, their practice, implant choice, surgical technique, post-op care, revision surgery, and impact of breast implant-associated anaplastic large cell lymphoma among several other questions. There were a total of 166 respondents, with 146 completing the survey fully, equaling a response rate of approximately 73%. Overall, there were specific trends in certain aspects such as type of practice, number of augmentations performed per surgeon per year, preferred implant manufacturer, and implant characteristics. That said, there has been a change in other aspects such as implant texture with an increase in the use of smooth implants. The United Kingdom and Ireland concur with certain internationally dominant practice preferences, including the use of inframammary incisions and post-op bra use. This survey suggests that many aspects of breast augmentation surgery in the United Kingdom are approaching standardization. There are, however, some variations in practice and controversies remaining as expected. It is our belief that further standardizing this very common aesthetic surgical procedure according to evidence-based guidelines will help to improve outcomes for patients.

Single-Institution Early Experience With a New, Smooth, Opaque, and Round Breast Implant Over a 2-Year Period.

The ideal breast implant does not exist and the choice of implant for breast augmentation is largely based on what surgeons think will be best for their patients. To evaluate the preliminary results of a new, smooth, round, and opaque breast implant (PERLE, GC Aesthetics; Dublin, Ireland) from a single-center UK aesthetic practice. Retrospective cohort study of all patients undergoing breast implant surgery with PERLE at the authors' center between January 2021 and December 2022. Outcomes data such as rates of capsular contracture, infection, revision surgery, and synchronous mastopexy were analyzed. Of the 385 patients identified, 374 (97.1%) had PERLE implants placed by 3 surgeons for primary (n = 290) and secondary breast augmentation (n = 21), and augmentation-mastopexy (n = 63). Capsular contracture occurred in no cases, infection in 1 (0.2%), and revision surgery in 21 patients (5%). The incision used was always submammary, unless a synchronous mastopexy was performed; implants were placed in the subglandular/subfascial plane in the majority of cases (85.3%), and the rest were dual plane (14.7%). Eight revisions were performed in patients undergoing breast augmentation (due to implant displacement in 6 patients, and hematoma and infection in 1 patient each). Fourteen revisions were performed in those undergoing augmentation-mastopexy. The average follow-up time was 18 months. The authors' early, single-center experience with PERLE implants suggests a safety profile and overall complication rate that is comparable with other modern implants. They will continue to monitor the safety and effectiveness of PERLE and discuss the reasons and evolution in the choice of breast implant.

Efficacy of the Modified 5-Item Frailty Index in Predicting Surgical-Site Infections in Patients Undergoing Breast Implant Augmentation: A National Surgical Quality Improvement Project-Based 5-Year Study.

The ability to predict breast implant augmentation complications can significantly inform patient management. A frailty measure, such as the modified 5-item frailty index (mFI-5), is becoming an increasingly established risk factor for adverse postoperative outcomes. The authors hypothesized that the mFI-5 is predictive of 30-day postoperative complications in breast augmentation. To investigate if mFI-5 can predict the likelihood and magnitude of 30-day complications resulting from breast augmentations. A retrospective review study of the National Surgical Quality Improvement Program database for patients who underwent breast implant augmentation without other concurrent procedures, from 2015 to 2019. Age, BMI, number of major comorbidities, American Society of Anesthesiologists (ASA) classifications, smoking status, mFI-5 score, and modified Charlson comorbidity index score were compared as predictors of all-cause 30-day complications and 30-day surgical-site complications using regression analyses. Overall, 2478 patients were analyzed, and among them, 53 patients developed complications (2.14%). mFI-5 score significantly predicted surgical-site infection (SSI) complications (odds ratio [OR] = 4.24, P = .026). Frail patients had a higher occurrence of SSIs than nonfrail patients (P = .049). Multivariable analyses showed ASA class predicted 30-day SSI complications (OR = 5.77, P = .027) and mFI-5 approached, but did not reach full significance in predicting overall 30-day complications (OR = 3.14, P = .085). To date, the impact of frailty on breast implant procedure outcomes has not been studied. Our analysis demonstrates that the mFI-5 is a significant predictor for SSIs in breast implant augmentation surgery and is associated with overall complications. By preoperatively identifying frail patients, the surgical team can better account for postoperative support to minimize the risk of complications.

Comorbid Conditions and Complications in Body Contouring Surgery: A Retrospective Review.

Body contouring procedures have significantly increased in popularity in the United States. The authors sought to understand, categorize, and classify patients' experiences with postoperative complications following common body contouring procedures. PearlDiver (PearlDiver Technologies, Colorado Springs, CO), a database with over 90 million patients, was queried to identify patients who had undergone body contouring procedures between 2010 and 2021 using current procedural terminology (CPT) codes. The authors identified patients who underwent panniculectomy, abdominoplasty, brachioplasty, thighplasty, mastopexy, breast augmentation, augmentation mastopexy, breast reduction, and liposuction for analysis. They reviewed combined procedures and analyzed risk factors associated with the most common complications. There were 243,886 patients included in the study. The majority of patients were female, between 50 and 59 years old, and had their procedures performed in the southern United States. There were an average of 25,352 procedures per year. The majority of cases involved breast surgeries. The most common preoperative comorbid conditions diagnosed 1 year before surgery were hypertension, obesity, and diabetes. The most common postoperative complications within 90 days were wound dehiscence, hematoma, and urinary tract infection. A logistic regression evaluating the association of the preoperative comorbid conditions with postoperative complications found that patients with obesity, tobacco use, diabetes, and hypertension had an increased risk of developing wound dehiscence, hematoma, and surgical-site infection. The data suggest that patients with obesity, tobacco use, diabetes, and hypertension undergoing body contouring surgery are at greater risk of developing wound dehiscence, hematomas, and surgical-site infections. Understanding this data is imperative for providers to adequately identify associated risk factors, stratify patients, and provide adequate perioperative counseling.

Safely Shaping the Breast After Implant Removal and Total Intact Capsulectomy Using the Mammary Imbrication Lift and Fixation Technique.

Implant-based breast augmentation is one of the most popular plastic surgery procedures performed worldwide. As the number of patients who have breast implants continues to rise, so does the number of those who request breast implant removal without replacement. There is little in the current scientific literature describing total intact capsulectomy and simultaneous mastopexy procedures. Here, the authors present their current method using the mammary imbrication lift and fixation technique after explant and total capsulectomy. Between 2016 and 2021, a total of 64 patients (mean age: 42.95 years; range, 27-78 years) underwent the described mammary imbrication lift and fixation technique with bilateral breast implant removal and total capsulectomy. Mean follow-up was 6.5 months (range, 1-36 months). Postoperative complications included minor cellulitis in 1 patient (1.6%), late onset hematoma with infection in 1 patient (1.6%), fat necrosis and pulmonary embolism in 1 patient with prior history of thromboembolic events (1.6%), and breast scar irregularity in 4 patients (6.2%) who required subsequent minor scar revision or steroid injections. Two patients (1.6%) underwent revision surgery with bilateral breast fat grafting to improve shape and add volume. The mammary imbrication lift and fixation technique described here can safely and simultaneously be performed with a total intact capsulectomy and explant procedure. This technique avoids wide undermining, intentionally opening the capsule, performing subtotal capsulectomy, and preserving blood supply to the breast tissue and nipple with low complication rates.

The New Era of Marketing in Plastic Surgery: A Systematic Review and Algorithm of Social Media and Digital Marketing.

Abstract Social media has been demonstrated to serve as a critical tool for plastic surgeons, facilitating patient engagement, peer-to-peer education and learning, and outreach to the broader public community. This study aims to perform a meta-analysis of data to determine the most valuable and useful social media platforms for practicing plastic surgeons developing their practice by assessing the perceived value to the practice and quantifying return on investment. A systematic review was performed using PubMed (National Institutes of Health, Bethesda, MD). The initial search yielded 3592 articles. Sixteen articles met inclusion and exclusion criteria. It was found that patients are more likely to engage with aesthetic content rather than scientific content. Younger generations are more likely to utilize Instagram (Meta, Menlo Park, CA), Snapchat (Santa Monica, CA), and TikTok (Culver City, CA), while older generations may be more likely to utilize Facebook (Meta, Menlo Park, CA) and YouTube (San Bruno, CA). Age-specific recommendations include utilizing Instagram, Snapchat, and TikTok with emphasis on breast augmentation for patients aged 17 and 35 given this is the most common procedure performed for this age group. Patients between the ages of 36 and 70 are most likely to be engaged on Facebook, Instagram, and Facebook with liposuction being the most common procedure in this age group. For ages 70+, patients are most likely to utilize Facebook with the most common procedure performed as blepharoplasty. Effective social media marketing for the plastic surgeon considers delivering the right content and choosing the right platform. The right content and platform are critically dependent on the specific age of the audience. Level of Evidence: 3